MEDICARE: JENNIFER KEAST LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C007585	NC

General Provider Information

NPI Number	:	1679706634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KEAST LCSW

Provider Business Mailing Address
First Line	:	514 DAWLEY DR
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-4820
Country	:	US
Telephone Number	:	919-810-1495
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E ACADEMY ST STE 104
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2248
Country	:	US
Telephone Number	:	919-770-1860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	05/06/2024

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